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‘Tailored’ approach cuts broad spectrum antibiotic use for sepsis

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An interdisciplinary approach to antimicrobial stewardship involving comprehensive blood culture identification (BCID) testing can slash broad spectrum antibiotic use, according to US researchers.

As a result, they were able to “tailor” the antibiotic regimen and ultimately improve care, resulting in patients being on broad spectrum antibiotics for a whole day less than normal.

“We are able to tailor patients’ antibiotic regimen and ultimately improve their care”

David Ezdon

Their findings were presented this week at the Association for Professionals in Infection Control and Epidemiology (APIC) annual conference in Philadelphia.

The innovation saw a new protocol to treat sepsis patients implemented by the microbiology lab at the Einstein Medical Center Montgomery in Pennsylvania, working in collaboration with an antimicrobial stewardship team.

Rapid BCID polymerase chain reaction (PCR) tests were administered to identify the bacteria making the patient sick, and pharmacists made recommendations on how to manage or readjust the previously prescribed antibiotic regimen.

Data collected for four months before and after implementation showed that the new BCID PCR test protocol resulted in clinicians adjusting antibiotic treatment a full 25 hours sooner on average, decreasing time spent on broad spectrum antibiotics.

Pharmacists’ recommendations were developed using an algorithm that determines the best course of treatment for the type of bacteria indicated by the BCID PCR test results.

By optimising antibiotic use, the researchers said the Montgomery Hospital observed a length of stay reduction of 1.45 days per patient, which also resulted in savings of £254,458 over four months.

“This scenario illustrates the success that antimicrobial stewardship programmes can achieve”

Karen Hoffman

Lead study author David Ezdon said: “Reducing the use of broad spectrum antibiotics is essential in slowing the growth of resistant bacteria.

“Through rapid blood culture identification tests, we are able to tailor patients’ antibiotic regimen and ultimately improve their care,” he said.

Karen Hoffman, nurse and current president of APIC, said: “This scenario illustrates the success that antimicrobial stewardship programmes can achieve when healthcare providers, pharmacists, and infection preventionists work together.

“Antimicrobial stewardship programmes require co-ordination across multiple disciplines to achieve the larger goal of preserving antibiotic therapy for future generations,” she added.

Antimicrobial stewardship programmes encourage the appropriate use of antimicrobials to minimise overuse, improve outcomes, reduce microbial resistance, decrease the spread of infections, and preserve the efficacy of antibiotics.

Multidrug-resistant organisms cause a significant proportion of serious healthcare-associated infections and are more difficult to treat because there are fewer and, in some cases, no antibiotics that will cure the infection.

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